Clinical Scenario

During afternoon consultations, Mrs Harper brings Molly the labrador to see you for her regular arthritis check up. At the end of the consultation you ask Mrs Harper if she needs more meloxicam dispensing. Mrs Harper assures you that she has plenty of meloxicam at home, as she no longer gives Molly the full dose every day. She has reduced Molly's dose to around two thirds of the prescribed dose, only giving the full dose when she has a "bad day". You wonder if reducing the dose in this way will mean that Molly is in pain....

3-Part Question (PICO)

In [dogs with osteoarthritis] does [reducing the dose of meloxicam compared to maintaining at the indicated dose of 0.1mg/kg daily] [increase the pain associated with osteoarthritis]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

((dog$ or canine$ or canis).mp. or exp Dogs/)

AND

((osteoarthriti$ or osteo-arthriti$ or joint Disease$ or djd or oa or arthriti$).mp. or exp Osteoarthritis/ or exp Arthritis/ or exp Joint Diseases/)

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Comments

The updated search for this BET conducted in February 2018 identified the original version of the BET published in the Veterinary Record (Doit and Wareham, 2016) however no additional primary research was identified.

Summary of Evidence

Wernham et al (2011) USA

Title:

Dose reduction of meloxicam in dogs with osteoarthritis-associated pain and impaired mobility

Number of dogs dropping out because owner deemed pain control insufficient

HCPI score (Helsinki Chronic Pain Index)

CBPI scores (Canine Brief Pain Inventory)

AM counts (Activity Monitor)

%BW (Body weight distribution) - the percentage of body weight distribution through each limb over a 5 second period while standing on a pressure sensitive walkway

CSOM (Client Specific Outcome Measures) - a selection of activities which were problematic for the dog, unique for each dog, assessed at each visit.

Client records of adverse events

Key Results:

Significantly more dogs dropped out of the reduced dose group (RDG) compared to the maintenance dose group (MDG) during the study (13/30 in the RDG versus 6/29 in the MDG, p=0.03).

MDG had a significantly slower rate of drop out than the RDG (p=0.035)

In the RDG, 26/30 dogs (87%) tolerated at least a 15% reduction in dose

For the dogs that remained in the study: overall there were no significant differences between the two groups for CBPI, HCPI, %BW, activity monitoring or CSOM

For the dogs that dropped out of the study: there was a significant deterioration in CBPI, HCPI and CSOM (p<0.05) but not in %BW index

Adverse events: occurred in 5 dogs, 3 in RDG and 2 in MG. All recovered except 1 which died

Study Weaknesses:

Although they calculated that 31 dogs will be needed in each treatment group (total 62 dogs), after 65 dogs enter the study, unfortunately 6 drop out before the first assessment (reported not to be related to pain control). This left 59 dogs for the remainder of the study which makes the sample size too small

Some outcomes are measured subjectively e.g. pain scoring

Group comparisons for some outcome measures only reported using dogs that did not drop out of the study i.e. comparisons only made between subgroups of dogs in which pain was adequately controlled

Attachment:

No attachments.

Comments

Bottom line

Dose reduction of meloxicam in dogs with osteoarthritis led to significantly increased signs of pain compared to dose maintenance, however dose reduction was tolerated in some dogs.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It
is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on
the specific circumstances of patients under their care, taking into account other factors such as local
licensing regulations. Read small print

References

Doit H, Wareham K (2016) Can you reduce the dose of meloxicam in dogs with osteoarthritis? Veterinary Record 179: 600-601